Ms A complained that Aneurin Bevan University Health Board (“the Health Board”) did not follow appropriate guidelines when making its decision not to progress a retrospective Continuing Health Care (“CHC”) claim to an Independent Review Panel.
The Ombudsman was concerned that whilst the Health Board had loosely followed the requirements of the CHC National Framework, the Independent Chair’s rationale for not moving to an Independent Review Panel was generic, and did not specifically address concerns raised. The Independent Chair did not address a legitimate concern regarding the date of CHC eligibility.
The Ombudsman sought and gained the Health Board’s agreement to, within 1 month, refer the case to a different Independent Chair to reconsider whether an Independent Review Panel is warranted, with the new Independent Chair addressing the specific point about the date of CHC eligibility. The Ombudsman also gained agreement for the Health Board to confirm that all future Independent Chair decisions will be accompanied with case specific rationale, and that evidence of this process would be provided within 2 months.